Intestinal ischemia

Intestinal ischemia (is-KEE-me-uh) describes a variety of conditions that occur when blood flow to your intestines decreases due to a blockage, usually in an artery. Intestinal ischemia can affect your small intestine, your large intestine (colon) or both.

Intestinal ischemia is a serious condition that can cause pain and make it difficult for your intestines to work. In severe cases, loss of blood flow to the intestines can damage intestinal tissue and lead to death.

Treatments are available for intestinal ischemia. To improve the chances of recovery, it's crucial to recognize the early symptoms and get medical help right away.

Colon and small intestine

Signs and symptoms of intestinal ischemia can develop suddenly (acute) or gradually (chronic). The condition presents differently in different people, so no one set of signs and symptoms indicates intestinal ischemia, but there are some generally recognized patterns.

Symptoms of acute intestinal ischemia

Signs and symptoms of acute intestinal ischemia typically include:

Sudden abdominal pain that may range from mild to severe

An urgent need to have a bowel movement

Frequent, forceful bowel movements

Abdominal tenderness or distention

Blood in your stool

Nausea, vomiting

Fever

Mental confusion in older adults

Symptoms of chronic intestinal ischemia

Signs and symptoms of chronic intestinal ischemia can include:

Abdominal cramps or fullness after eating, usually within the first hour, and lasting one to three hours

Abdominal pain that gets progressively worse over weeks or months

Fear of eating because of subsequent pain

Unintended weight loss

Diarrhea

Nausea, vomiting

Bloating

When to see a doctor

Seek immediate medical care if you have sudden, severe abdominal pain. Pain that makes you so uncomfortable that you can't sit still or find a comfortable position is a medical emergency.

If you have other signs or symptoms that worry you, make an appointment with your doctor.

Intestinal ischemia occurs when the blood flow through the major arteries that supply blood to your intestines slows or stops. The condition has many potential causes, including a blockage in an artery caused by a blood clot, or a narrowing of an artery due to buildup of deposits, such as cholesterol. Blockages also can occur in veins, but they're less common.

Whatever the cause, diminished blood flow within your digestive tract leaves cells without enough oxygen, which causes the cells to weaken and die. If damage is severe enough, infection, gangrene and eventually a hole (perforation) in the wall of the intestines can occur. If untreated, intestinal ischemia can be fatal.

Intestinal ischemia is often divided into categories:

Colon ischemia (ischemic colitis)

This most common type of intestinal ischemia occurs when blood flow to the colon is slowed. It most often affects adults older than 60, although it can develop at any age.

Signs and symptoms of colon ischemia include rectal bleeding and the sudden onset of mild, crampy abdominal pain. The cause of diminished blood flow to the colon isn't always clear, but a number of conditions can make you more vulnerable to colon ischemia:

Buildup of cholesterol deposits on the walls of an artery (atherosclerosis)

Twisting of the bowel (volvulus) or trapping of intestinal contents within a hernia

Excessive bowel enlargement from bowel obstruction caused by scar tissue or a tumor

Other medical disorders that affect your blood, such as inflammation of your blood vessels (vasculitis), lupus or sickle cell anemia

Some medications, especially those that constrict blood vessels, such as some heart and migraine medications, and hormone medications, such as estrogen

Cocaine or methamphetamine use

Vigorous exercise, such as long-distance running

Acute mesenteric ischemia

This type of intestinal ischemia usually affects the small intestine. It has an abrupt onset and may be due to:

A blood clot (embolus) that dislodges from your heart and travels through your bloodstream to block an artery, usually the superior mesenteric artery, which supplies oxygen-rich blood to your intestines. This is the most common cause of acute mesenteric artery ischemia and can be brought on by congestive heart failure, an irregular heartbeat (arrhythmia) or a heart attack.

A blockage that develops within one of the main intestinal arteries and slows or stops blood flow, often as a result of fatty deposits (atherosclerosis) building up on the wall of an artery. This type of sudden ischemia tends to occur in people with chronic intestinal ischemia.

Impaired blood flow resulting from low blood pressure due to shock, heart failure, certain medications or chronic kidney failure. This is more common in people who have other serious illnesses and who have some degree of atherosclerosis. You may hear this type of acute mesenteric ischemia referred to as nonocclusive ischemia, which means that it's not due to a blockage in the artery.

Chronic mesenteric ischemia

Chronic mesenteric ischemia, also known as intestinal angina, results from the buildup of fatty deposits on an artery wall (atherosclerosis). The disease process is generally gradual, and you may not require treatment until at least two of the three major arteries supplying your intestines become severely narrowed or completely obstructed.

A potentially dangerous complication of chronic mesenteric ischemia is the development of a blood clot within a diseased artery, causing blood flow to be suddenly blocked (acute mesenteric ischemia).

Ischemia that occurs when blood can't leave your intestines

A blood clot can develop in a vein draining deoxygenated blood from your intestines. When the vein is blocked, blood backs up in the intestines, causing swelling and bleeding. This is called mesenteric venous thrombosis, and it may result from:

Acute or chronic inflammation of your pancreas (pancreatitis)

Abdominal infection

Cancers of the digestive system

Bowel diseases, such as ulcerative colitis, Crohn's disease or diverticulitis

Disorders that make your blood more prone to clotting (hypercoagulation disorders), such as an inherited clotting disorder or taking a medication such as estrogen that can increase clotting risk

Buildup of fatty deposits in your arteries (atherosclerosis). If you've had other conditions caused by atherosclerosis, such as decreased blood flow to your heart (coronary artery disease), legs (peripheral vascular disease) or the arteries serving your brain (carotid artery disease), you have an increased risk of intestinal ischemia. Being older than 50, smoking, and having high blood pressure, diabetes or high cholesterol increases your risk of atherosclerosis.

Blood pressure problems. Having blood pressure that is too high or too low increases your risk of intestinal ischemia.

Heart problems. Your risk of intestinal ischemia is increased if you have congestive heart failure or an irregular heartbeat such as atrial fibrillation.

Medications. Certain medications may increase your risk of intestinal ischemia, including birth control pills and medications that cause your blood vessels to expand or contract, such as certain allergy medications and migraine medications.

Go the emergency room if you have severe abdominal pain that makes you so uncomfortable that you can't sit still. You may be referred for immediate surgery to diagnose and treat your condition.

If your abdominal pain is moderate and predictable — for example, it always begins soon after eating — call your doctor for an appointment. When you call to set up an appointment, you may be referred to a specialist, such as a gastroenterologist or vascular surgeon.

Here's some information to help you get ready for your appointment.

What you can do

Ask about pre-appointment restrictions. When you make your appointment, ask if there's anything you need to do in advance, such as restrict your diet. It's likely your doctor will ask you not to eat after midnight the night before your appointment.

Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down other medical conditions, such as a blood clot,or procedures you've had.

List all medications, vitamins and supplements you take. If you take birth control pills, write down the drug's name.

Take a family member or friend along. Someone who accompanies you can help you remember what your doctor says.

Write down questions to ask your doctor.

For intestinal ischemia, some questions to ask your doctor include:

What is likely causing my condition?

What are the possible causes?

Do you think my condition is temporary or chronic?

What tests do I need?

What treatments do I need?

If I need surgery, what will my recovery be like? How long will I be in the hospital?

How will my diet and lifestyle change after surgery?

What follow-up care and treatments will I need?

Should I see a specialist?

Is there a generic alternative to the medicine you're prescribing?

Are there brochures or other printed material I can have? What websites do you recommend?

If your doctor suspects intestinal ischemia, you may undergo several diagnostic tests, based on your signs and symptoms, including:

Blood tests. Although there are no specific blood markers to indicate intestinal ischemia, laboratory study of a blood sample that shows, say, an increase in white cell count, might suggest intestinal ischemia.

Imaging tests. Imaging tests may help your doctor see your internal organs and rule out other causes for your signs and symptoms. Imaging tests may include X-ray, ultrasound, CT scan and MRI.

Using a scope to see inside your digestive tract. This technique involves inserting a lighted, flexible tube with a camera on its tip into your mouth or rectum to view your digestive tract from the inside. The camera can be inserted in your mouth (endoscopy) to help see the upper portion of your small intestine. The camera can also be inserted in your rectum to view the last 2 feet of your colon (sigmoidoscopy) or to view your entire colon (colonoscopy).

Using dye to track blood flow through the arteries. During angiography, a long, thin tube (catheter) is inserted into an artery in your groin or arm, then passed through the artery to the aorta. A dye is injected that flows directly to your intestinal arteries. X-ray images are then taken that show the dye moving through your arteries.

If you have intestinal ischemia, the images may show a blocked or narrowed artery. Angiography also allows the doctor to treat a blockage in an artery by injecting medication or using special tools to widen an artery.

Exploratory surgery. In some cases you may need exploratory surgery to find and remove damaged tissue. Opening the abdomen allows diagnosis and treatment during one procedure.

Colon ischemia

Your doctor may recommend antibiotics to treat or prevent infections. Your doctors also can treat any underlying medical condition, such as congestive heart failure or an irregular heartbeat. You'll need to stop medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs. Colon ischemia may also heal on its own.

If your colon has been damaged, you may need surgery to remove the dead tissue. Or you may need surgery to bypass a blockage in one of your intestinal arteries.

Acute mesenteric artery ischemia

Surgery may be necessary to remove a blood clot, to bypass an artery blockage, or to repair or remove a damaged section of intestine. Treatment also may include antibiotics and medications to prevent clots from forming, dissolve clots or dilate blood vessels.

If angiography is done to diagnose the problem, it may be possible to simultaneously remove a blood clot or to open up a narrowed artery with angioplasty. Angioplasty involves using a balloon inflated at the end of a catheter to compress the fatty deposits and stretch the artery, making a wider path for the blood to flow. A spring-like metallic tube (stent) also may be placed in your artery to help keep it open.

Chronic mesenteric artery ischemia

Ischemia due to mesenteric venous thrombosis

If your intestines show no signs of damage, you'll likely need to take anticoagulant medication for about three to six months. If tests show you have a blood-clotting disorder, you may take anticoagulants for the rest of your life. Anticoagulants help prevent clots from forming. If portions of your bowel show signs of damage, you might need surgery to remove the damaged section.